Changing the conversation about health

“Prioritise children and value primary care”: Sam Everington pens an open letter to new NHS England chair Richard Meddings

The College of Medicine’s Sir Sam Everington has penned an open letter, published in the Health Service Journal, to the new NHS England chair Richard Meddings on the future of the NHS and how the healthcare system can be improved. You can read it in full here:

Dear Richard,

The NHS has some of the lowest number of beds, nurses and doctors in Europe and one of the highest GDP spent on it, and now over 6 million patients on the waiting list.

On 1 July, I and many other clinicians around the country end our role as chairs and system leaders of clinical commissioning groups. 

I wish you all the best and hand on some tips.

1. Don’t just rely on the papers your executives put in front of you. You and your non-executive directors need your own network throughout the NHS to find out what is going on at the coal face, without layers of “interpretation”.

Sir Sam Everington, pictured at a College of Medicine event in 2019, has written an open letter to the incoming NHS Chair Richard Meddings, outlining his hopes for the NHS

2. Appoint NEDs that are challenging and produce creative discomfort. We need people around us that tell us when we are doing something stupid.

3. Make sure you have plenty of patients around you that test everything you do and decide.

4. NHS England workforce has massively expanded under covid. Redirect many of the teams back to the coal face to focus on day-to-day patient delivery in hospitals and the community.


5. Ask yourself if the make-up of NHS boards match the integrated care mission.

6. Data and documents produced by NHSE are funded by the taxpayer. None of it should be confidential unless this is absolutely essential.

7. Clinicians in the NHS spend money in the daily decisions they make, but few are engaged in managing systems, budgets and population health and you are just about to lose a significant number of primary care system leaders. You will never get the NHS finances under control and waiting lists down if clinicians are not engaged at all levels of the organisations.

8. Please stop the spin in press releases and ensure the NHS workforce get the news first or at least at the same time as the national media. You are not the government.

9. Encourage all your staff to be open and make good, timely, evidence-based decisions. This will encourage leadership behaviour and innovation at all levels.

10. Beware if someone likes or insists on their titles being used (Sir, Professor!). Check if they are delivering for patients.

Sir Sam Everington speaking in 2020 about the obesity crisis amongst children in the UK

11. Value primary care. It is not perfect but incredibly cost effective and takes, at its best, significant burden away from hospitals. In NHSE, the vast majority of your clinical team and leadership is from the acute sector. You need the right people in the room to ensure the decisions made are the right ones. Remember that for every 2.7 hospital beds, 1,000 are managed in the community by primary care and about half of the doctors are GPs.

12. I count at least 22 separate regulators in the NHS. You are slimming them down, but the balance of resource put into regulation versus quality improvement needs to change, along with an understanding that command and control is just one technique of engineering change. Enabling and encouraging innovation and cooperation at all levels of the NHS will often deliver far more.

13. Ensure every regulator has a wider responsibility to patient care and prevention rather than sitting within their narrow remit. Integrated care will not be delivered unless you ensure all the regulators take an integrated approach.

14. Approximately 47 per cent of people with terminal illness die in hospital. The “vanguards” showed that this could be reduced by two thirds. The only person I have ever come across who would choose to die in hospital rather than in their community surrounded by their loved ones, was a chief executive of an acute trust!

15. Waiting lists are not just solved in hospital. I believe at least 65 per cent of referrals could be managed with the specialist “advice and guidance” system for GPs, which typically gives patients a solution within a week rather than sitting on long or hidden waiting lists.

16. I am nearer to the end of life than the beginning. Most of the NHS budget is spent on people of my age. Meanwhile the health of children has deteriorated, even prior to covid. Forty per cent of 11-year-olds in London are overweight or obese (I like to call it malnourished) and there is only one school nurse for six schools. Are we fair in the NHS budget we apply to children, and shouldn’t we have a nurse in every school and on every school governing board?

17. Our organisation motto at Bromley by Bow is fun, friendship, compassion and assume it is possible – what is yours?

Finally, in anything you do or decide, always ensure the patients are in your heart and mind, as you are buffeted by “interests”.

Good luck and best wishes,

Sir Sam Everington